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As Revenue Cycle professionals, we are often asked to develop and present a “strategy” but we are rarely asked to address “tactics” per se. As a result, the defining line has blurred between the two. Take a moment to review the following and consider their importance and associated differences;

Strategy:

The science or art of military command as applied to the overall planning and conduct of large-scale combat operations.

Tactics:

The technique or science of securing the objectives designated by strategy, especially the art of deploying and directing troops, ships and aircraft in coefficient maneuvers against the enemy.

I submit that making this distinction is critical for healthcare revenue cycle and financial leaders. It is more than just semantics. The following illustrates its impact on how we approach things.

Hiring:
When asking job candidates interview questions about how they might handle certain situations or operating conditions, do you get a tactical response or a strategic answer? Perhaps if the candidate focuses mostly on tactics, you would consider them for different roles than if they provide more strategic responses.

Managing Change:
Your organization has acquired multiple facilities over the course of recent years and the question of centralized AR processing hits the table. Are you thinking about development of a strategic plan or are you speculating about how billing data will be transferred (and the multitude of other tactical challenges inherent in this initiative)? Unfortunately, businesses often “skip” strategic thinking and planning when addressing key opportunities. This often leads to the conclusion that the original idea was a bad one or that people have underperformed when the reality was simply that an absence of strategy caused a great idea to fail implementation.

So when you are considering a central business office, integration of physician billing, a computer conversion, a denial management plan, or any other initiative, develop and test a strategy before you leap into the tactical component.

We hope this and other practical experiences Nearterm has accrued over the recent 20 years will be of value to you. We have served in both strategic and tactical roles with our clients and we would welcome your call us at 281-646-1330 if you have questions.

We all want to contribute to the success of our respective organizations. A mentor of mine once imparted to me a simple management tenet that helped me over the years to do just that. He said, “Employees determine what is important based on how you spend your time”. Because my mentor was a brilliant healthcare leader and a great human being, I took this seriously and felt compelled to interpret his subtle advice. Here is what he really told me:

When people embrace importance, they act accordingly. In the workplace, when employees recognize that what they do is important and/or that their work will result in something important to their organization, they get engaged. This translates to creativity, harmony, efficiency, ownership and stability.

When people are asked to participate in tasks and activities that are not perceived as important, the result is very different, particularly in light of the generational diversity in the workplace today. If you want to test that, ask a GEN Y employee to do something without some explanation of purpose and why it is important. Or for baby boomers, a great example was the scene in the old movie “Cool Hand Luke” where a prisoner was repeatedly asked to dig a hole then fill it back in again to “break” him. It was not important and so the prisoner continued efforts to escape until his death, certainly not the behavior the warden was after.

The key question then, is how do employees determine what is important? It is less based on things like what a manager writes in a memo, what the manager says or posts on the wall. It is how the manager spends his/her time. Here are a couple examples:

In patient financial services, account documentation is an important part of the work process. In our revenue cycle consulting practice, we review work samples as part of our discovery process. That means looking at accounts. When we find absent or poor documentation and ask the business office manager about it, we find that they do not routinely look at a sufficient sample of accounts to have made the observation on their own. Employees no longer think it’s important so either discontinue writing up account history or do a hap-hazard job. Spend more time randomly reviewing account stratifications and discussing findings with employees. It becomes important and documentation improves.

Most hospital controllers and hospital chief financial officers would concur that maintaining logs is an important function. At the beginning of the fiscal year, they tell the accounting staff it is important and back it up with a memo or email. Fast forward as other priorities emerge over the course of the year. The CFO spends time working on the bond issue or the new building project and deploys the accounting staff accordingly. The accounting staff perceives those issues must be important and does a great job supporting those initiatives. Now it is time to do the cost report, the logs are summoned and we learn they have not been maintained since the second quarter. Nobody asked to see them or otherwise spent time on the logs all year.

The idea is to consider how you spend your time in the context of how your presence influences what people think is important. We can’t be everywhere and certainly there is nothing wrong with job descriptions, emails, memos, verbal direction and other communications. Just bear in mind that at the top of the communication hierarchy is “how you spend your time”.

In overview, you might want to reflect on how you have invested your time and presence over the recent month. Another effective way to assess what employees think is important is to ask them casually and privately, then listen carefully to what they say (not a survey that gives them a lot of time to construe what you want to hear in lieu of what they really think). Perhaps the result would represent an opportunity for you to rethink or fine-tune your management practices as I did.

Over recent years, approximately two thirds of those hired in healthcare management positions were acquired through a search firm. Most hiring authorities and HR professionals are therefore acquainted with the significant differences among these firms and the various levels of service they provide. That said, there are a number of reasons healthcare provider organizations use search firms and the following is a brief summary you might find useful in confirming the value of such services:

Search professionals help you access “hidden candidates”. These are candidates who are very happy in the current employment scenario. They typically do not have the time or interest to look at ads and they would not answer them if they did. They are not looking for jobs. Often, these are highly desirable candidates for obvious reasons. Through research and other techniques, competent recruiters identify and build relationships with hidden candidates on your behalf.

Search professionals help you avert “sight seers”, people interviewing without serious interest or compatibility. This saves you considerable time, money and aggravation.

Search professionals help you by bringing “confidence” in the probability that a candidate you are working with would accept the position if offered. Issues like compensation, relocation, family/personal matters and others are addressed by the firm before you advance too much time and energy in the process of considering the candidate.

Search professionals uphold the highest standards of “confidentiality” in all they do. That allows them to conduct search activities inside your organization as well as individuals you have targeted outside of your organization but were reluctant to pursue directly for various reasons.

Search professionals are experts in “on-boarding” and can assist you with this process. On-boarding is a critical element of a successful transition of the newly hired candidate into your organization. It is well documented that organizations that have adopted an active on-boarding process experience fewer failed hiring attempts.

The above is only a summary. If you would like to discuss this topic further or you have comments, please feel free to contact Nearterm at 281-646-1330.

Almost all provider organizations engage Revenue Cycle Consultants or Interim Revenue Cycle Managers from time to time. A lot has been published through HFMA about vendor selection criteria and vendor management. Most professional organizations offer a resource guide that lists options.

That said, here are two practical things to consider when hiring these resources:

Far too often when organizations hire external resources that will be deployed to their patient financial services, finance or health information management departments, they consider only the person OR the company supplying the resource.

In order to better leverage your investment; be certain that you are hiring quality resources supported by an offering company with deep expertise in revenue cycle management operations.

You are importing expertise and human capital to your organization and those values are not found in the company logo, rather they are delivered through the people serving you. Therefore, it is important to interview the specific people who will be working with you. Is the chemistry good? Do they have the technical background required? Have their achievements with other clients been commensurate with expectations you have in your organization? This interview process allows you to access what you are buying without the influence of a logo, business development person or other external factors.

It is then a value added if you select a professional services company with the capacity to leverage the people selected. Once you have interviewed the consultant or interim director, pursue how the offering vendor achieves synergy by supporting the engagement with a brain trust, technical depth, management practices and other props. At Nearterm, we have (a) a quality assurance program called Q-100, (b) Principals with successful background leading provider organizations and (c) a mechanism for our field professionals to access our collective resources and expertise on a real time basis when engaged in development and/or problem solving endeavors. As a result our clients have the benefit of professionally managed resources with access to a cache of experience, eliminating the “trial and error” approach.

We always have to consider cost. I submit that in most cases, when provider organizations identify sustained operating deficits, performance problems, extended vacancies in key positions and backlogs, the real cost is in NOT getting help from an external resource.If these items could have been addressed internally, they would have already been resolved. Losses can be measured in terms of cost of cash and also balance sheet losses. Often the extra set of eyes and new ideas represented by an interim CFO or interim Business Office Director are just the change catalyst needed to improve performance. An Interim Controller can assist finance with accelerating close schedules and new formatting so that management reports are more timely and useful. Regardless of the issue, always think about the cost of inaction in terms of financial performance and even career development.

Posted By: Nearterm Houston

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RCM Management

Nearterm Healthcare Interim Management Services is offered as a standalone service or as a part of 360° multidiscipline, multiservice solution for improving financial performance in general or when dealing with change and transition. More ...